Growing up as the youngest of 11 children in an immigrant family, Rep. Tony Cárdenas often didn’t have access to health care services.

Now, the California Democrat is calling for a wide-ranging legislative package to address concerns about equity and mental health heightened by the COVID-19 pandemic. The $1 billion, nine-bill package, shared first exclusively with CQ Roll Call, aims to capitalize on Democratic control of both chambers and the White House.

“What’s happened is like when the tide goes out. All of a sudden you see the bottom of the ocean floor, right, and you start to see what’s down there. But the people who live in these communities, we knew about these disparities,” he said. “I’ve experienced those disparities myself.”

Cárdenas, who sits on the Energy and Commerce Committee, outlined three policy areas that form the basis of several bills that focus on addressing minority inequalities exacerbated by the pandemic. He plans to formally introduce the bills in the House soon and feels confident that they will have the support of Energy and Commerce Chairman Frank Pallone Jr., D-N.J., and Health Subcommittee Chairwoman Anna G. Eshoo, D-Calif.

“So far, I haven’t had any resistance that tells me that it’s not going to be able to be done,” he said.

Cárdenas sees the package moving as part of a larger COVID-19 relief vehicle, such as President Joe Biden’s $1.9 trillion proposal. He did not indicate the number of current co-sponsors.

Mental health advocates have warned that the pandemic would likely heighten existing behavioral health concerns, and early data has already shown increases in suicide deaths in some localities. Black and other minority communities are facing the dual challenges of COVID-19 and racism.

Michelle A. Williams, dean of the faculty at the Harvard T.H. Chan School of Public Health, highlighted these mental health concerns for minority populations, front-line workers and young people during a recent briefing.

“There is no vaccine for mental illness. It will be months, if not years, before we are able to grasp the scope of the mental health issues borne out of this pandemic,” she said at the Harvard event.

Cárdenas said he has been working with other Energy and Commerce members — including Democratic Reps. Yvette D. Clarke of New York and Raul Ruiz of California — and Sens. Bob Menendez, D-N.J., Michael Bennet, D-Colo., and Ben Ray Luján, D-N.M.

“Their heart’s in the right place, and we’re going to be leaning on them to continue to support and help get this legislation into law,” he said.

He and other lawmakers contacted House leadership last year during ongoing pandemic relief negotiations with concerns about vulnerable communities. In his home state of California, Latinos are 2.6 times more likely to test positive for COVID-19 than white individuals.

Data published by The Commonwealth Fund in 2020 showed that Latinos, women and low-income individuals are at the highest risk of behavioral health issues related to the pandemic.

“This pandemic has just raised and amplified the problems that the Latino community has,” said Margarita Alegría, chief of the disparities research unit at Massachusetts General Hospital and a psychiatry professor at Harvard Medical School, at a briefing this week hosted by the Robert Wood Johnson Foundation. She added that economic instability can lead to stress: “These are the groups that have been hardest hit by job loss.”

Legislative package

Cárdenas’ legislative package is split into three focus areas: health equity, behavioral health and nutrition. “Health disparities, especially for poor families and families of color in America, are about as drastic as it’s ever been in this country, and the pandemic has exposed it tremendously,” he said.

The health equity prong would include four different bills.

The first bill would expand emergency services for individuals who don’t meet Medicaid’s citizenship requirements. State Medicaid coverage for immigrants varies by state. This bill would clarify that undocumented immigrants would also have access to testing, treatment and vaccinations for COVID-19.

Cárdenas said he does not expect most of his Republican colleagues to push back on this policy, but he did not name any Republican co-sponsors.

The second bill would require state plans to report information about health inequities within communities of color to the Substance Abuse and Mental Health Services Administration and would encourage hiring more culturally and linguistically competent mental health providers.

“Sometimes, if, if an organization is trying to serve someone, and that’s someone who’s an adult, and that someone doesn’t speak very much English, you might be talking to a 6-year-old child, and that child is trying to translate in a nervous way to their mother and the doctor or the nurse or the pharmacist or what have you. Guess who had to do that for his parents? Me,” Cárdenas said. “I know what it’s like. And I know that the standard of care is diminished when you don’t have culturally competent providers.”

The other two bills would attempt to reduce the disproportionate impact COVID-19 has had on vulnerable minority populations and would require HHS to create a task force to study physician shortages.

Another section of the legislation would focus on behavioral health and includes four bills. This legislation would authorize SAMHSA to improve behavioral health support in schools during and after the pandemic, establish mental health and suicide prevention grants in schools, build community-based behavioral health services, and simplify the approval process for local Crisis Counseling and Training Programs.

The final prong focuses on nutrition and includes legislation that would allow Supplemental Nutrition Assistance Program recipients to also qualify for food programs funded under Federal Emergency Management Agency Public Assistance Program funds.

“We are going to try to normalize those disparities down to the point where hopefully we can’t tell that there are any disparities in the future. But today there are, and the numbers don’t lie,” Cárdenas said.